Sunday, January 8, 2012

Pica (Eating Disorder)

Pica is an eating disorder typically defined as the persistent ingestion of nonnutritive substances for a period of at least 1 month at an age at which this behavior is developmentally inappropriate (eg, >18-24 mo).

The definition is occasionally broadened to include the mouthing of nonnutritive substances.

Although pica is observed most frequently in children, it is the most common eating disorder in individuals with developmental disabilities.

In some societies, pica is a culturally sanctioned practice and is not considered to be pathologic. Pica may be benign, or it may have life-threatening consequences.

In children aged 18 months to 2 years, the ingestion and mouthing of nonnutritive substances is common and is not considered to be pathologic. Consider pica when the behavior is inappropriate to the developmental level of the individual, is not part of a culturally sanctioned practice, and does not occur exclusively during the course of another mental disorder (eg, schizophrenia).

If pica is associated with mental retardation or pervasive developmental disorder, it must be sufficiently severe to warrant independent clinical attention. In such patients, pica is typically considered to be a secondary diagnosis. Furthermore, the pica must last for a period of at least 1 month.

Pica is a serious behavioral problem because it can result in significant medical sequelae. The nature and amount of the ingested substance determine the medical sequelae.

Pica has been shown to be a predisposing factor in accidental ingestion of poisons, particularly in lead poisoning. The ingestion of bizarre or unusual substances has also resulted in other potentially life-threatening toxicities, such as hyperkalemia following cautopyreiophagia (ingestion of burnt match heads).

Exposure to infectious agents via ingestion of contaminated substances is another potential health hazard associated with pica, the nature of which varies with the content of the ingested material.

In particular, geophagia (soil or clay ingestion) has been associated with soil-borne parasitic infections, such as toxoplasmosis and toxocariasis.